title: Reversion to susceptibility of a carbapenem-resistant clinical isolate of Klebsiella pneumoniae producing KPC-3.
abstract: OBJECTIVE
  We report the case of a kidney-transplant patient, suffering an intra-abdominal abscess at the surgical site caused by a carbapenem-resistant ST258 Klebsiella pneumoniae clone, producing the KPC-3 carbapenemase. Under tigecycline treatment, the patient developed a sepsis caused by a carbapenem-susceptible ST258 K. pneumoniae strain. Complete DNA sequences of the plasmids carried by the resistant and susceptible strains from this patient were determined.
  
  
  METHODS
  The complete DNA sequences of plasmids were obtained by applying the 454 Genome Sequencer FLX-PLUS procedure on a library constructed of total plasmid DNA purified from the carbapenem-resistant and -susceptible strains.
  
  
  RESULTS
  In the carbapenem-resistant strain, four plasmids encoding 24 resistance genes, including blaKPC-3, and two putative virulence clusters were detected. In the susceptible strain, large rearrangements occurred in the KPC-carrying plasmid, causing the deletion of the entire Tn4401::blaKPC-3 transposon, with the consequent reversion of the strain to carbapenem susceptibility. The patient was successfully treated with carbapenems and fully recovered.
  
  
  CONCLUSIONS
  The description of the plasmid content in these two strains gives interesting insights into the plasticity of KPC-carrying plasmids in K. pneumoniae.
authors.affiliation: Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Villa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capone
authors.forename: Daniela
authors.initials: D
authors.lastname: Fortini
authors.forename: Monika
authors.initials: M
authors.lastname: Dolejska
authors.forename: Irene
authors.initials: I
authors.lastname: Rodríguez
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Taglietti
authors.forename: Paolo
authors.initials: P
authors.lastname: De Paolis
authors.forename: Nicola
authors.initials: N
authors.lastname: Petrosillo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Carattoli
mesh_terms: D018784:Abdominal Abscess / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000378:metabolism*; D015780:Carbapenems / Q000494:pharmacology*; D004251:DNA Transposable Elements; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D042822:Genomic Instability; D006801:Humans; D016030:Kidney Transplantation; D007710:Klebsiella Infections / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D010957:Plasmids / Q000032:analysis; D017422:Sequence Analysis, DNA; D013530:Surgical Wound Infection / Q000382:microbiology; D014180:Transplantation; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D004251:DNA Transposable Elements; D004269:DNA, Bacterial; D001618:beta-Lactamases; C063912:carbapenemase
keywords: plasmids; sequence type 258; transplant